A CASE OF GASTRIC CANCER WITH MALROTATION OF INTESTINE REQUIRED RE-OPERATION FOR REFLUX ESOPHAGITIS AFTER TOTAL GASTRECTOMY

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  • KAWANO Fumiaki
    Second Department of Surgery, Miyazaki University School of Medicine
  • SEKIYA Ryo
    Second Department of Surgery, Miyazaki University School of Medicine
  • SHINOHARA Tatsuo
    Second Department of Surgery, Miyazaki University School of Medicine
  • UCHINO Hirofumi
    Second Department of Surgery, Miyazaki University School of Medicine
  • ONITSUKA Toshio
    Second Department of Surgery, Miyazaki University School of Medicine

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  • 胃全摘術後の逆流性食道炎にて再手術が必要であった腸回転異常症の１例

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Abstract

We report a case of gastric cancer with malrotation of intestine required re-operation for refflux esophagitis after total gastrectomy. A 64-year-old man found to have an elevated lesion at the gastric cardia by screening endoscopy. He admitted to the hospital with a diagnosis of well differentiated adenocarcinoma of the stomach. Abdominal CT scan showed non-anatomic displacement of the small intestine and colon and SMV rotation sign as well. We conssidered that he had gastric cancer with intestinal malrotation. During surgery, the duodenum was not fixed to the retroperitoneum and the Tritz's ligament was absent. The small intestine was located on the right side and the colon on the left, the cecum and ascending colon did not fixed to the retroperitoneum. The findings of the bowel indicated malrotation of nonrotation type. A total gastrectomy with Billroth II reconstruction was carried out because the jejunum was lifted to the esophagus easily. Intestinal fixation was not conducted. Postoperatively he complained of heartburn, nausea and vomiting. Endoscopic examination revealed esophagitis caused by bile reflux, and upper esophagointestinal series revealed that the lifting jejunum was fallen at the left upper abdomen to become a lump. The procedures for re-operation included cut of the afferent loop of jejunum and anastomosis to the ileum with 30cm anal side. Then we fixed the afferent jejunum to abdominal wall for prevention against shortening and volvulus. His symptoms as well as esophagitis on endoscopy disappeared after the re-operation.

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